Stick to it

Edward Le Cara, DC, PhDJanuary 22, 2015

Implementing kinesiology taping in your practice.

It is common as a chiropractor to have patients experience amazing results while in your care. Improved range of motion, decreased pain, and an overall improved sense of well-being are typical outcomes. Unfortunately, many times those results are short-lived and the pain and restrictions soon return.

In this scenario, patients can become frustrated and may seek treatment elsewhere because they are only seeing temporary relief of symptoms. This is an indication that the patient needs activities beyond manipulation to maintain the positive results the treatment provides.

Certain areas of the body, namely the cervical and lumbar spine, scapulae, mid-foot, elbow, and knee, require stabilization after times of mobilization or manipulation because they need to be inherently stable, not excessively mobile. The brain will create the stability around those joints by making the muscles around the area hypertonic, thus giving the patient a sense that the area is “tight.”

A common prescription is to give stretching exercises to these areas to minimize the tightness, but this can make the muscles irritated as they try to provide stability. As a clinician, you can render stabilization with Kinesiology tape (K-tape).

Taping for support and posture can provide the stability the brain wants and allow the muscles to relax. The patient will no longer feel the constant tightness and his or her range of motion will be restored.

If you understand how to use K-tape and exercise post-manipulation, you’ll optimize your ability to get better outcomes. In addition to stimulating the central nervous system with manipulation, taping and exercising the area after manipulation can provide sustainable stabilization benefits. Increased volume and intensity of exercises can be added over time and voila: The patient no longer has symptoms, and you are the hero.

Mechanism of action

There is a body of work that examines how an initial episode of back or neck pain can lead to ongoing changes in input from the spine. Over time, these changes lead to altered sensorimotor integration of input from the spine and limbs.

Research findings have indicated that areas of spinal dysfunction represent a state of altered afferent input that may be responsible for ongoing central plastic changes.1-4 Furthermore, this may be a potential mechanism that could explain how high-velocity, low-amplitude spinal manipulation improves function and reduces symptoms. They have proposed that:

Altered afferent feedback from an area of spinal dysfunction alters the afferent ‘milieu’ into which subsequent afferent feedback from the spine and limbs is received and processed, thus leading to altered sensorimotor integration (SMI) of the afferent input, which is then normalized by high velocity, low-amplitude manipulation.1

This is an academic way of saying that misalignment of the spine interferes with the central nervous system and manipulation helps to restore normalcy. Post-manipulation changes can be seen with improved range of motion and decreased pain not only to the segments manipulated but to the extremities as well.

Unfortunately, even after the pain is gone and the tissue has healed, the muscles have already learned what it’s like to be hurt. Therefore, the benefit tends to be only temporary.

Previously injured muscles need proper stimulus to reset so they can contract properly. K-taping can be one piece of the puzzle that contributes to teaching the muscles how to be normal again.

Theory into practice

Further research demonstrates that K- taping may be an “efficacious therapy due to subtle mechanisms affecting the brain, not just because it gives mechanical support.”5 The tape provides afferent mechanoreceptor stimulus to the brain, and the brain will perceive stability.

In the case of the cervical spine, if the area is stable, the brain does not have to tighten up the muscles around the neck to provide stability. In addition, the patient will be cued to keep the head in the proper posture, which leads to other benefits.

When you manipulate or apply myofascial release to areas that require inherent stability, follow manipulation with something to stimulate the central nervous system. In the cervical spine area, you can use a simple “H” K-taping technique (see Figure 1).

When the patient gains a sense of stability from the tape, have him or her perform exercises that maintain the stability through muscular contraction. For the cervical spine, activate the deep cervical flexors for seven-second holds. Start with five repetitions and work up to two sets of 10 repetitions.

Remind the patient to breathe through the diaphragm while performing these exercises, in through the nose for four seconds and out through the nose for six seconds. If it is too difficult to breathe properly, the exercise is too difficult.

How long will the muscular return to normalcy last? You’ll likely find that those who are more active tend to see greater benefits from this type of care. Have patients who are not active increase their cardiovascular activity if possible.

Whenever you manipulate or mobilize an area that requires stability, consider using K-tape post-manipulation to increase afferent stimulation to the brain. The brain in turn will provide pain mitigation and improve motor control, thus eliminating the need for the muscles to be hyperactive in providing stability.

If motor control exercises are used in conjunction with manipulation and K-taping, you’ll likely discover even better effects.

Edward Le Cara, DC, PhD, ATC, CSCS, recently sold his practice of 14 years in California and relocated to Dallas. He is the director of athletic training at The KinetikChain and the Director of Trans Global education at RockTape. He can be contacted at ed@rocktape.com, on Twitter and Instagram at @drlecara, or through rocktape.com.